Simulation for Attending Obstetricians to Improve Technical Skills for Managing Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a rare but potentially catastrophic obstetric emergency, and a leading cause
of severe maternal morbidity and preventable mortality in the U.S. Women of racial and ethnic minority groups
and living in underserved and remote areas are at greatest risk. Obstetric units must be prepared to manage
PPH, and obstetric (OB) attendings must maintain technical skills necessary to control PPH. To address this,
simulation is a promising approach. Obstetric simulation has shown effectiveness for team-based training, yet
there is compelling evidence for the use of simulation to improve technical skills. Further, prior studies and
simulation research from other surgical specialties demonstrate the high likelihood of successfully validating an
existing high-fidelity simulator and establishing its effectiveness in training OB attendings in technical skills
needed to manage PPH. However, a simulation program directed at OB attendings who work in varied hospital
settings across the country is subject to known obstacles for implementing and spreading simulation. We
propose a staged, multicenter study to establish simulation, using innovative approaches to mitigate barriers,
as an effective means for training OB attendings in three technical skills demonstrated as effective for
controlling PPH: Bakri balloon placement, B-Lynch suture placement, and O'Leary suture placement. OB
attendings will be assessed at baseline, mentored, and re-assessed. The primary outcomes will be change in
assessment scores (measured by validated and widely used OSATS) and change in percentage of OB
attendings who achieve competency (score of 60) from baseline to program completion. Our main hypotheses
are that the PPH technical skills simulation program will show a significant increase in skill level among OB
attendings and that the proposed innovations (affordable, remote, asynchronous) will address known barriers
to implementation. We propose the following specific aims: Aim 1: Establish simulation as an effective means
for training OB attendings in technical skills for treating PPH by validating a high-fidelity simulator and
rigorously evaluating its effectiveness for a PPH technical skills simulation program with an in-person
mentoring program. Aim 2: Evaluate three innovations aimed at overcoming common barriers to simulation
training for OB attendings: Aim 2A: Validate a novel, affordable medium-fidelity simulator and evaluate its
effectiveness in a PPH technical skills program using in-person mentoring; Aim 2B: Evaluate a PPH technical
skills simulation program with remote synchronous mentoring; Aim 2C: Evaluate a PPH technical skills
simulation program with asynchronous mentoring. Aim 3: Evaluate the effectiveness of a PPH technical skills
simulation program in rural and community hospital settings, using the approach that sufficiently addresses the
barriers to implementation established in Aim 2 (affordable, remote, asynchronous) and is acceptable to OB
attendings. If successful, results will inform best practices in obstetrics, advance integration of simulation in
medical education and training standards, and enable dissemination in varied settings nationwide.
1

Grant Number: 5R01HD107451-04
NIH Institute/Center: NIH
Principal Investigator: Jason Adelman